{include file="public/header"/}

{include file="public/navleft" info=$info/}

<body data-type="generalComponents">


<div class="tpl-page-container tpl-page-header-fixed">



    <div class="tpl-content-wrapper">
        <div class="tpl-content-page-title">
            Amaze UI 表单
        </div>
        <ol class="am-breadcrumb">
            <li><a href="#" class="am-icon-home">首页</a></li>
            <li><a href="#">表单</a></li>
            <li class="am-active">Amaze UI 表单</li>
        </ol>
        <div class="tpl-portlet-components">
            <div class="portlet-title">
                <div class="caption font-green bold">
                    <span class="am-icon-code"></span> 表单
                </div>
                <div class="tpl-portlet-input tpl-fz-ml">
                    <div class="portlet-input input-small input-inline">
                        <div class="input-icon right">
                            <i class="am-icon-search"></i>
                            <input type="text" class="form-control form-control-solid" placeholder="搜索..."> </div>
                    </div>
                </div>


            </div>
            <div class="tpl-block ">

                <div class="am-g tpl-amazeui-form">


                    <div class="am-u-sm-12 am-u-md-9">
                        <form class="am-form am-form-horizontal">
                            <div class="am-form-group">
                                <label for="user-name" class="am-u-sm-3 am-form-label">医院代号： / ID</label>
                                <div class="am-u-sm-9">
                                    <input type="text" id="user-name" placeholder="姓名 / Name">
                                    <small>输入医院代号**六位数***。</small>
                                </div>
                            </div>

                            <div class="am-form-group">
                                <label for="user-name" class="am-u-sm-3 am-form-label">医院名称： / Name</label>
                                <div class="am-u-sm-9">
                                    <input type="text" id="user-names" placeholder="姓名 / Name">
                                    <small>输入医院名称**。</small>
                                </div>


                            </div>

                            <div class="am-form-group">
                                <div class="am-u-sm-9 am-u-sm-push-6">
                                    <button type="button" class="am-btn am-btn-primary">点击增加</button>
                                </div>
                            </div>

                        </form>
                    </div>
                </div>
            </div>

        </div>


    </div>

</div>


<script src="/static/js/jquery-2.1.1.js"></script>
<script src="/static/js/amazeui.min.js"></script>
<script src="/static/js/iscroll.js"></script>
<script src="/static/js/app.js"></script>
</body>
</html>
{include file="public/footer"/}